@SarahMc So you probably know already that a low dose doesn't mean anything and yes I stopped at 6.25 because it was a quarter of a tablet and my doctor told me it was a super low dose and I definitely regret it.

If you're already sensitized as you describe I would go slower than 10% of the current dose you still have to do this hyperbolically I would do no more than 5% reductions. Even on Tegretol the reductions I'm doing are not even 3% and my body still feels it. The low dose you are on needs to be tapered very slowly especially in your situation and I would get down to well below 1 mg before jumping off which is what I wish I had done. I made the mistake of thinking that a 25 mg it was not much more than an antihistamine and that that was a very low dose compared to what I had been on so I didn't think it was necessary at the time but I was misinformed. I had not yet found surviving antidepressants.

Sorry you're having such a difficult time I definitely understand so you're going to have to feel your way through this and go very very slowly.

Thanks @Feralcatman — that’s all basically what I figured, but it’s still nice to hear about it from someone who’s been through it so thanks! And yes I understand that a “low dose” doesn’t mean much. My psychiatrist told me that 12.5 mg “doesn’t do anything” and that I should be able to hop off at any time, which clearly wasn’t true. Like you, I hadn’t yet found this forum or even figured out that all the med changes were responsible for my symptoms quite yet.

Sounds like you’ve been through quite a lot — thanks so much for sharing what you’ve learned along the way.

19 hours ago, Feralcatman said:

I can finally nap again without getting completely destroyed

Thanks for the update FCM, I very pleased to hear about your naps! I wish I could manage this!

So antidepressant withdrawal has gotten a little bit of air time and thought people would like to hear this interview.

https://www4.wng.org/The-withdrawal-question.mp3

Edited July 1Jul 1 by Feralcatman

15 hours ago, Feralcatman said:

So antidepressant withdrawal has gotten a little bit of air time and thought people would like to hear this interview.

https://www4.wng.org/The-withdrawal-question.mp3

Feel free to post in the media area

CAUTION

So there are people out there reporting success using the Keto Diet. Obviously results will vary from person to person as with everything else due to individual physiology, genetics, exposures, trauma history, etc.

I heard from someone doing this diet and they reported back that their symptoms returned when their ketone levels dropped significantly though still in ketosis.

So be aware that this is not likely a cure, it is a band aid that when removed reveals the true condition of your nervous system same as a medication that reduces symptoms. There are no long term studies on this diet with relation to protracted withdrawal and yet there are known harms for doing it long term even in healthy people. These include kidney stones, kidney damage, and increased insulin sensitivity and possible induction of type 2 diabetes if you have to transition back to a normal diet as it can cause loss of the ability to properly manage blood glucose levels. If it his helping your symptoms then be aware that stopping it could bring a return of symptoms and that you may have to transition back to a normal diet very slowly as suddenly swapping back to glucose as fuel could be seen as a shock to a sensitive nervous system. That would mean a careful dietary taper. Also remember that if you are on this diet and have something happen to you that requires a hospital stay they will not keep you on this diet and so you may have a sudden return of symptoms while in the hospital recovering from whatever put you there. As with anything this may not happen with everyone so you'll only find out the hard way.

In my opinion anything that seems to be a quick fix will most likely have a severe down side to it so please be aware and be cautious.

So I know there are not many people on Tegretol otherwise known as carbamazepine but there are a few and if you are in a polypharmacy situation it can complicate things with this drug so I put together a guide that people can use because I haven't come across any doctor who has any idea what to do. I also started a separate thread on this that is a continuation of my surviving antidepressants thread that is yet to be approved but contains more details.

What Happens When You Taper Tegretol While on Other Medications: A Patient’s Guide to Metabolic Unmasking

If you are trying to taper off Carbamazepine (Tegretol) while taking other medications (like an SSRI) and finding that your doctors cannot explain what is happening to your body, you are not alone. Most medical training focuses on single medications, leaving a massive blind spot when it comes to the complex math of liver enzymes.

Based on lived experience, biochemical mechanics, and what happens when the system shifts, here is what you need to know about what to expect during a Tegretol taper in a polypharmacy situation:

1. The "Accelerator" Effect (Auto-Induction & Broad Enzymes)

Tegretol is a unique medication because it is an auto-inducer and a heavy liver enzyme accelerator.

• When you take Tegretol long-term, it forces your liver to pump out extra enzymes to burn through the drug.

• It doesn't just affect one pathway; Tegretol strongly induces major liver pathways like CYP3A4, CYP2C9, CYP2C19, and UGT glucuronidation.

• Because your liver is running so fast on these shared pathways, it also burns through any other medications you are taking at the same time much faster than it normally would.

2. The "Unmasking" When You Taper (And the Shared Pathway Effect)

When you start lowering your Tegretol dose, you are taking your foot off the accelerator.

• The liver slows down: As the Tegretol drops, your liver’s enzyme production eases back toward baseline on those major pathways.

• Your other medications rise: Because the liver is no longer burning through your other medications at hyper-speed, the effective concentration of those other drugs in your blood can quietly rise—even if you haven't changed their pill dose at all.

• The Shared Pathway Ripple Effect (Why it affects Paxil): Even if a drug like paroxetine (Paxil) relies heavily on a pathway Tegretol doesn't directly target (like your genetic variant's bottleneck, CYP2D6), Paxil's breakdown also relies on CYP3A4—which is Tegretol's primary target. When Tegretol lifts its heavy induction pressure on CYP3A4, and your system is already struggling with a CYP2D6 genetic bottleneck, the Paxil has nowhere to go. It backs up in your system, creating a functional overdose of your other medications.

3. The Compounding Impact of Existing Protracted Withdrawal

If you are already navigating protracted withdrawal from a previous medication (such as Seroquel), the landscape changes significantly:

• Heightened Nervous System Vulnerability: A nervous system dealing with protracted withdrawal is already in a state of chronic instability, neuroplastic remodeling, and autonomic dysregulation. It lacks the robust baseline resilience of a healthy, uninjured system.

• Amplified Reactivity: Because your nervous system is fragile, it reacts much more intensely to minor biochemical shifts. Changes in effective drug levels that a healthy body might shrug off can trigger severe, disproportionate systemic flare-ups when protracted withdrawal is already present.

• Masked vs. Overlapping Symptoms: It can be difficult to untangle what is direct drug toxicity from your current taper versus what is a wave of protracted withdrawal. Both conditions independently drive deep fatigue, autonomic swings, and mood shifts, meaning they heavily compound and amplify one another.

4. What Symptoms to Expect

Because your body chemistry is actively shifting beneath your feet, a Tegretol taper in polypharmacy isn't just about "Tegretol withdrawal." You may experience:

• Shifting Symptoms: You might notice a transition over time—for example, moving from high-activation symptoms (like inner restlessness or anxiety) to heavy, activated depression, profound fatigue, an increased need to nap, or difficulty handling stress.

• Cortisol and HPA Axis Shifts: Changes in stress hormone regulation (such as lower tested cortisol levels compared to previous years) can add layers of deep exhaustion and sluggishness.

• Nervous System Overload: Your nervous system has to constantly readjust as the effective doses of your other drugs drift upward against an already vulnerable baseline.

5. Useful Labs to Monitor Progress (And How to Time Them)

To see what is actually changing beneath the surface, specific blood work can provide objective data, provided you account for the mechanics:

• Serum Tegretol & Active Metabolite Levels: To track how your body is clearing the medication as auto-induction shifts. Whenever possible, ask for free (unbound) drug levels alongside total levels to see the actual biologically active amount circulating past your protein carriers.

• Consistent Timing (Trough vs. Peak): Always draw your blood work at the same time relative to your last dose (usually trough, right before your next dose) so you are comparing apples to apples.

• Liver Function Tests (LFTs): To monitor hepatic workload and enzyme adaptation.

• Complete Blood Count (CBC): To check immune and bone marrow stability during metabolic transitions.

6. How to Protect Yourself (Survival Tips)

Since many doctors are unfamiliar with these specific metabolic mechanics, you have to advocate fiercely for your own stability:

• Go Slow: Small, conservative drops (like tiny 5 mg adjustments) give your liver and your fragile nervous system time to catch up to the shifting drug interactions.

• Plan for Long Holds: Giving your body an extended, predictable window of stability (such as holding a dose steady for months or a year) allows your liver enzymes and effective drug levels to finally settle into a permanent baseline.

• Expect Non-Linear Recovery: Healing and stabilizing are rarely a straight line, especially with a history of protracted withdrawal. You will likely experience windows of clear improvement mixed with intermittent flare-ups.

• Document Everything: Keep your own logs of your doses, symptoms, and lab results. When doctors draw a blank, having your own timeline of data is the best tool you have.

You aren't imagining things, and your body's protests are rooted in real, hard biochemistry. Understanding the math of liver enzymes and the reality of a vulnerable nervous system can take some of the fear out of the unpredictable symptoms, helping you protect yourself as you fight your way toward stability.

Edited August 10Aug 10 by Feralcatman

UPDATE

So as of August 1st 2026 I have gone into my 6th year of protracted withdrawal from Seroquel and I am a couple of years into my tapering of Tegretol. Starting in February I've been able to start napping again as previously mentioned however I have had a switch from more activation type symptoms to more fatigue and activated depression type symptoms and this summer my sleep problems have gotten noticeably worse. I am still having the adrenaline wakings pretty much every night that I call rude Awakenings. I've definitely have quite a lot more symptomatic days this summer than I did last year but I'm also on significantly less medication so it may just be a matter of my body trying to adjust to the seasons with less glutamate suppression. It's hard to say so we'll just see where this goes. As of today I am down to 205 mg of Tegretol from the 400 mg I was on and I'm going to do one more cut so I can start splitting pills and then I'm going to take a year off and let my body stabilize and then take it from there because things have definitely gotten a little bit worse and I'm starting to get restrictions on what I can do for exercise again so my body definitely needs a break. Some of why this is happening might be what is mentioned in the thread I posted prior to this one as well as in the Tegretol thread that I just posted but I don't really know so it's just going to be one day at a time and see what happens. I will update again when I have more details.

Edited August 10Aug 10 by Feralcatman

UPDATE

So since this whole thing began and even when I was still on high-dose meds I noticed that I had problems with humidity and I was never 100% sure if it was the heat or the humidity but I know I can handle dry heat. For years now I typically did better in the fall, winter, and early spring. I bought a Garmin Smartwatch a few weeks ago to start tracking things and the watch generates something called a body battery score which combines sleep metrics with overall heart rate variability, pulse, oxygen levels, whatever training you do, and other data. Everyday you get a high score and a low score which shows how you are recovering. I was doing okay until the end of July and all of a sudden my body battery started to go way down and I looked at the historical weather and that correlates with when the humidity consistently went way up by comparison to what it had been. I've also been getting more histamine symptoms on some days and of course humidity traps pollutants and allergens and concentrates them. Stupidly I just kept pushing with my walks, my exercise, and working on my property, all outdoors, but I pushed a little too hard so I've had a rough few days and now I can definitely see what the trigger was.

As I suspected quite a while ago, I react badly to humidity and this can happen in the winter too if it gets really wet and humid for more than a day and I have to exert myself. The only difference is now I have a way to measure it and actually see it. So when you combine any kind of stress and trying to exercise and make some gains and then you add in another stressor from the environment it's enough to cause your autonomic nervous system to start freaking out and cause a wave.

So when you combine psychosocial and environmental stress with the fact that I'm still having these rude Awakenings every night it becomes pretty easy to see why I'm still having trouble because my body already has a hard time getting rested and recovered. Yet another indicator that some of what these drugs do is create an iatrogenic dysautonomia which of course is going to make you more reactive and less able to deal with changes in stress in the environment. Very interesting to actually watch it happen in real time but now I'll be able to use this watch more effectively to gauge what I can do and when I can't do on any given day.

This is why after I do my next cut I'm going to hold for at least a year possibly more to let my body recover so I can get some of my strength back and actually live the life I want to live. Part of why I'm having a harder time this summer is because I'm on a lower level of Tegretol which among other things suppresses sympathetic response and glutamate so this year my sympathetic response has gone back up again and it needs time to recalibrate.

Protracted withdrawal is more than just messed up chemistry it is a structurally altered nervous system having to rebuild itself physically and as with any nerve injury it takes a long time for it to rebuild and restructure. So I don't think it's the individual cuts that have been the trigger for symptoms but it's the overall lower suppressive effect that's reducing my adaptive reserve which then limits my ability to cope with the environment and physical and psychosocial stress.

If anybody had told me that it would take this long to get off these meds and that it could **** you up that bad for this long I never would have done it this is why all these people that are out there pushing for informed consent and pushing for change deserve thanks because more and more people are getting ****** up every day and that needs to change.

Healing is happening 😉✌️😺😺😺

Edited August 11Aug 11 by Feralcatman

@Feralcatman holding for a year sounds like a lovely little break. I hope it’s enough time for you to see some meaningful healing. I’m coming to terms myself with the idea that I might be in for a much longer hold than anticipated to start to really heal some of the damage from my multiple med changes the past year. Seeing your resilience in dealing with your longer tapers on top of other health issues is inspiring, so thank you for your presence here 🙏💜.

@SarahMc Thank you I'm glad you're finding some of this helpful.

This process requires constant monitoring and reevaluation and adaptation on the part of the meat suit driver and it can be infuriating and exhausting at times. The only thing you can do is keep taking the next step. The only other option is to quit and even though sometimes I might feel like it I just don't have that in me. The fact is even though I am still dealing with some serious issues there are a lot of things that have gone away and stayed away as well and I have recovered quite a bit of my function just not as much as I would have hoped for at this point. That said I have also managed to reduce my Tegretol dose by 50% so when you think about that of course I'm still having problems and it's hard to tell how much is left over from the Seroquel and how much is my taper.

This is why I'm going to hold for at least a year and previously I held for 3 years before I touched anything again and it was necessary and helpful. So if that turns out to be what you need to do it's not the end of the road it's just another bump that the medical system is forcing us to drive over but ultimately you get over it and get to the other side of the bump and move on.

Healing happens 😉✌️😺😺😺

1 hour ago, Feralcatman said:

The only thing you can do is keep taking the next step. The only other option is to quit and even though sometimes I might feel like it I just don't have that in me. The fact is even though I am still dealing with some serious issues there are a lot of things that have gone away and stayed away as well and I have recovered quite a bit of my function just not as much as I would have hoped for at this point.

Really glad to hear that you've recovered a lot of function even if it's slower than you'd like. I think it's safe to say that I don't have quitting in me either...one way or another I'll get off these meds, but if a super long hold is necessary to make the process less painful then so be it!

1 hour ago, Feralcatman said:

So if that turns out to be what you need to do it's not the end of the road it's just another bump that the medical system is forcing us to drive over but ultimately you get over it and get to the other side of the bump and move on.

Hear hear.

P.s. lol @ "meat suit driver". I love it 😂

Hi @Feralcatman , do you have any advice for someone who took a singular Seroquel 25mg dose and is experiencing a huge adverse reaction? What exactly do you think such a low dose did? I haven't been able to really sleep at all, and my body feels like its literally falling apart. Will this actually ever get better through time? Did that histamine blocking really **** things up?

@Kahran Looking at your drug history that's most likely the problem and the reaction you had to Seroquel was a paradoxical reaction due to the kindling effect of all of your other medications. Looks like the paradoxical reaction started with the Lorazepam earlier this year. I would recommend not taking any other neuro active medications including things like Benadryl which is actually heavily neuroactive and just give it time ultimately it will start to correct itself I just can't tell you how long. Adding in any other medications May likely have the same result and just make things worse so give it a lot of time.

UPDATE

So two days after this last cut of my Tegretol which was a 2.4% cut of 5 mg I suddenly developed a new symptom that I've never had in my life. Body dysphoria. Anyone else ever get that from making a cut or reducing their meds when they've never had it before. My internal critic also started screaming quite loudly at the same time.

21 minutes ago, Feralcatman said:

UPDATE

So two days after this last cut of my Tegretol which was a 2.4% cut of 5 mg I suddenly developed a new symptom that I've never had in my life. Body dysphoria. Anyone else ever get that from making a cut or reducing their meds when they've never had it before. My internal critic also started screaming quite loudly at the same time.

you're probably the third person I've found with such a symptom, for me, it started on a full dose years ago, and now on a low dose it's very strong. How does it feel for you?

I personally believe that any physical/mental symptom can develop as a direct result of those drugs.

@Fullhealing agreed you can develop pretty much any symptom from both the drugs and the withdrawal from the drugs. How the **** this was supposed to be helpful is beyond me and I'm sorry you're having to deal with things like this as well.

30 minutes ago, Feralcatman said:

@Fullhealing agreed you can develop pretty much any symptom from both the drugs and the withdrawal from the drugs. How the **** this was supposed to be helpful is beyond me and I'm sorry you're having to deal with things like this as well.

Helpful for the big pockets /:

Thank you and hopefully it won't stay long for you, it's truly an awful symptom.

Edited August 23Aug 23 by Fullhealing

14 hours ago, Feralcatman said:

UPDATE

So two days after this last cut of my Tegretol which was a 2.4% cut of 5 mg I suddenly developed a new symptom that I've never had in my life. Body dysphoria. Anyone else ever get that from making a cut or reducing their meds when they've never had it before. My internal critic also started screaming quite loudly at the same time.

Im sorry to read FCM, what these drugs do to us is incomprehensible if I am honest. Nothing surprises me anymore.

UPDATE

Well this last cut of only 5 mg really did a number on me I'm still not recovered and it's been over two weeks. I think I got Pig piled in combination with summer heat and humidity and exertion. I was told Tegretol should be much easier to come off of compared to antipsychotics and antidepressants but that's definitely not true. I would say all the drugs are about the same it is more dependent on individual physiology and genetics as well as individual drug history and Trauma history more than which drug you're taking. The cut I did was only 2.4% it's pretty tiny and I've only reduced 40 mg since this time last year so that tells you just how powerful this drug really is especially when you already have protracted withdrawal. So my advice would be don't set expectations based on what other people say about what sort of time they had coming off an individual drug listen to your own body instead and let that be your guide.

4 hours ago, Feralcatman said:

Well this last cut of only 5 mg really did a number on me I'm still not recovered and it's been over two weeks. I think I got Pig piled in combination with summer heat and humidity and exertion. I was told Tegretol should be much easier to come off of compared to antipsychotics and antidepressants but that's definitely not true. I would say all the drugs are about the same it is more dependent on individual physiology and genetics as well as individual drug history and Trauma history more than which drug you're taking. The cut I did was only 2.4% it's pretty tiny and I've only reduced 40 mg since this time last year so that tells you just how powerful this drug really is especially when you already have protracted withdrawal. So my advice would be don't set expectations based on what other people say about what sort of time they had coming off an individual drug listen to your own body instead and let that be your guide.

Hey @Feralcatman, I'm sorry this one's been so tough for you. I agree there's no predicting any of this, it's all down to the individual and figuring out what's best for you. I hope you get some relief soon.

14 hours ago, Feralcatman said:

Well this last cut of only 5 mg really did a number on me I'm still not recovered and it's been over two weeks.

Sorry to hear FCM

14 hours ago, Feralcatman said:

I would say all the drugs are about the same it is more dependent on individual physiology and genetics as well as individual drug history and Trauma history more than which drug you're taking.

I completely agree, they all also have thier own little nasty traits too.

14 hours ago, Feralcatman said:

listen to your own body instead and let that be your guide.

100%

Hope things ease up for you soon

So I decided to make a YouTube video to describe my experience with the mental health system and thought people might like to see it. Feel free to share this wherever you like if you feel it appropriate and with whomever you feel appropriate.

12 hours ago, Feralcatman said:

So I decided to make a YouTube video to describe my experience with the mental health system and thought people might like to see it. Feel free to share this wherever you like if you feel it appropriate and with whomever you feel appropriate.

Hearing your voice speak this truth is as heartbreaking as it is empowering @Feralcatman

What a bitter, absurd irony it is when the very hands extended to heal become the ones that tear down your well-being, offering solutions that breed deeper darkness, only to retreat into callous silence and leave you to pick up the pieces alone.

Your journey strikes a painful, familiar nerve in my own story. I know that burning rage of realizing the sanctuary you trusted was the source of the harm, and the heavy solitude of piecing your life back together when the system turns its back.

Thank you for your fierce honesty in bringing this hidden reality out of the shadows; your words are a sanctuary for so many who have felt utterly erased.

Though the climb ahead is still demanding, your strength to keep standing is nothing short of heroic. I have absolute faith that your unbroken resolve will carry you out of this storm and into a dawn of full restoration, quiet serenity, and complete liberation. Keep fighting!